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8'Y1 CZnlf. <br /> Burnett County 7410 Co. Rd. K, No. 102, Siren,WI 54872 Office of Zoning Administrator m m o 0 <br /> APPLICATION FOR — LAND USE — PERMITS 3. <br /> TO THE ZONING ADMINISTRATOR:The undersigned hereby makes application for a Permit for the work described and Q <br /> located as shown herein. The undersigned agrees that all work shall be done in accordance with the requirement of the <br /> Burnett County Land Use Ordinance,Sanitation Code,and with all other applicable County Ordinances and the I s and <br /> regulations of the State of Wisconsin. w m° <br /> Cv <br /> a � <br /> c O <br /> OWNER TELEPHONE <br /> ADDRESS 17 '•fr- eL-:�t" po c4k,06VA-) K�";cr <br /> EMERGENCY/FIRE NUMBER ROADNAME <br /> L�LEGAL DESCRIPTION (see tax receipQ <br /> CONTRACTOR P-0 —^ L,149 <br /> TYPE OF PERMIT(S): DWELLING?/BUILDINGGARAGE/ACCESSORY STRUCTURE ADDITION O <br /> 0 O —� <br /> SANITARY PRIVY FILLING/GRADING CAMPING UNIT SUBDIVISION -t <br /> 5 o <br /> STRUCTURE/ADDITION USE: <br /> (Home/Cabin;Commercial Business; Bedroom; Deck;etc.) 2 0 <br /> 0 0 <br /> m <br /> 3 <br /> DIRECTIONS FOR PLOT PLAN DRAWING: (Aerial or top view) <br /> 1. Show the location and size of all existing buildings (EB) and all new buildings (NB) and indicate North (N). <br /> 2. Show the location of the well (yi),septic tank (ST),and drainfield (DF). i <br /> 3. Show dimensions in feet of thefollowing:(a)building to all lot lines,(b)building to center line of road,(c)building <br /> measurement to the ordinary high water mark of lake,stream, or river. iQ <br /> 4. If separate plans are submitted by an architect,engineer,builder,contractor,etc.,the plans must be sighed and <br /> dated by the owner, 0 <br /> NOTE: BUILDING/STRUCTURE LOCATIONS MUST BE STAKED FOR ONSITE VERIFICATION BEFORE A PERMIT CAN BE ISSUED. IN o (n <br /> 2 a <br /> PLOT PLAN A o o. <br /> S.N <br /> to G <br /> C') bN <br /> Q � oL <br /> 73 <br /> o <br /> IG <br /> J � <br /> g >>am <br /> e Dg'� '�'n m 77 <br /> CONDITIONS OF PERMIT: < H' Z S g,E Z <br /> 1. DRIVEWAY MUST MEET DRIVEWAY WIDTH REQUIREMENTS WITHIN 60 DAYS OF PERMIT ISSUANCE. p I <br /> 2. REMOVAL OR CUTTING OF TREES AND VEGETATION IS RESTRICTED ALONG SHORELINE. =N M <br /> 3. NO GRADING OR SHORELAND ALTERATIONS ARE ALLOWED UNLESS SPECIFICALLY PERMITTED. o' i O mm <br /> j Lr <br /> I declare that this application(including any accompanying schedule)has been examined by me and to the best of�ny knowl- C <br /> edge and belief it is true,correct and complete.I acknowledge that I am responsible for the detail and accuracy of I informarrn <br /> tion contained in this application(including any accompanying schedule)and I further declare that I recognize that,this infor- <br /> mation I am providing will be relied upon by the County of Burnett Wisconsin in determining whether to issued permit. 1 8`8 8 <br /> further accept all liability which may be a result of the County of Burnett relying on this information 1 am providing lin this ap- <br /> plication.I agree to permit county officials charged with administering county ordinances or other authorized person to have 0: p <br /> access to the above described premises at any reasonable time for the purpose of inspection. ' m <br /> Cl✓ L- �9 - <br /> SIGN HERE � f <br /> � N <br /> sign fu c� owner or 1 n tractop <br /> o : <br /> ZONING ADMINISTRATORJim No <br /> -n <br /> TOWNSHIP PERMITS MAYBE REQUIRED 8 u u m <br /> -- --- -.�__ 198888888 y <br />